Substitute House Bill No. 5561, also known as Public Act No. 26-146, establishes a five-year Medicaid rate review process set to begin on July 1, 2026. The Commissioner of Social Services is responsible for developing a systematic method to evaluate and potentially adjust Medicaid reimbursement rates, with a focus on aligning them with Medicare rates when possible. This initiative aims to improve access to care, enhance quality, and reduce acute care spending. The bill also requires the commissioner to streamline existing fee schedules for provider reimbursements and to gather public comments during the evaluation process. Starting January 15, 2028, annual reports detailing the evaluation outcomes and recommendations for provider compensation will be submitted to the General Assembly.

In addition to the rate review process, the bill modifies the Medical Assistance Oversight Council by replacing a nonvoting member with a representative from the Connecticut Dental Health Partnership's Dental Policy Advisory Council. It also mandates a report on Medicaid coverage for biomarker testing, including prior authorization requirements, to be submitted by October 1, 2026. Furthermore, the bill introduces new provisions regarding opioid prescriptions for Medicaid beneficiaries, requiring practitioners to consider non-opioid treatment options before prescribing opioids and allowing the Commissioner of Social Services to adopt regulations for implementation. Lastly, a working group will study the feasibility of compensating spouses providing personal care assistance to partners in state-funded home care programs, with findings due by January 1, 2027.

Statutes affected:
Raised Bill: 4-220
HS Joint Favorable Substitute: 4-220
File No. 445: 4-220